>> Good evening.

I'm psychiatrist Jeff Olver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now and it's twenty third year Matters of the Mind is a live call in program where you have the chance to choose the topic for discussion.

>> So if you have any questions concerning mental health issues ,give me a call here.

>> PBS for Wayne by dialing in the Fort Wayne area (969) 27 two zero or if you're calling anywhere coast to coast you may dial toll free at 866- (969) to seven to zero now on a fairly regular basis I am broadcasting live every Monday night from the spectacular PBS Fort Wayne studios which lie in the shadows of the Fort Wayne campus.

And if you'd like to contact me with an email question that I can answer on the air you may write me a via the Internet at matters of the mind all one word at a dog that's matters of the mind at a dog.

>> And I'll start tonight's program with an email I recently received.

It reads Dear Dr. Fauver, I have heard you mentioned that stress affects your genetics.

What affects a person more their genetics or the stress that they're under?

>> How does this work?

Well, basically it goes hand in hand.

>> It's actually called epigenetics.

Epigenetics will be the impact of the environment on your genetics now your genetics are how you're hardwired.

>> It's basically your software.

But like any software you have to have an outside influence to be able to activate the software.

>> We've got twenty three thousand genes and the genes are on chromosomes.

The chromosomes are packed up in these little substances called histones.

>> And if you think of this marvelous culinary invention called pigs in a blanket pigs in a blanket will be where you have those sausages are little hot dogs and they're wrapped up in flaky pastry and pigs in a blanket are kind of like how histones look on top of the chromosomes because if you think of pigs in a blanket you have to kind of open them up to be able to eat them well that's the way that chromosomes will be.

>> They're covered with histones and you have to open up those histones to be able to activate or deactivate the actual genes themselves.

Well, that's the process of epigenetics where stress and the environment, medical illnesses, the use of marijuana, the use of alcohol, all these outside influences can actually affect our genetics.

Your genetics might be totally benign unless they're activated .

We see this quite commonly with this condition called schizophrenia which is where people lose track of reality.

>> They might have some lingering genetics in there that are totally benign until somebody smokes marijuana smoking marijuana gives you two hundred times higher risk of activating those genes in what happens the histones open up and then you can either decrease the activation of genes that need to be activated by overmedicating them or you can activate genes by assimilating them so you can have you can offset the balance based on whether you overly inhibit them or overly activate them based on stresses and environmental influences that actually open up the histones and and that allows the methyl groups or the acetyl groups to actually act as a landing pad inside those histones on the chromosomes themselves.

And that's what will give you the abnormal genetics and supposedly that's what causes diseases.

>> There's some studies being done on rats right now looking at the impact of early life stress and what it does to the genetic profile of the rats and they're actually experimenting with a medication that is also used for a type of leukemia and this medication given to rats when they're exposed to early life stress decreases the likelihood later on they'll have depression or anxiety.

They can study that in rats.

I'm interested to see what the impact of that would be for humans because people will ask me all the time can't we just stop the childhood traumatic experiences these kids are enduring?

Why you can't I mean it'd be nice to just stop all childhood traumatic experiences but we live in an evil world and unfortunately that's not going to happen using medication for children who have been exposed to early trauma I don't know.

We'll see how that comes out over the course of time.

But if you're a child under seven years of age and you're exposed to severe trauma that highly predicts later on in your life you're going to have stress related anxiety and depression, you've got to be more jumpy.

You're going to have more trouble with putting up with things and one thing can lead to another.

So with that in mind, let's go to our first caller.

Hello, David.

>> Welcome to the mind.

Thank you.

In several countries outside of the US there's a medication by the name of Eggo melatonin which is among other places made in England and India and I am told that it will help someone sleep as well as suppress depression.

Do you know this drug?

>> Yeah, David, it's a medication that is not has not been approved by the Food and Drug Administration United States and because of that its ability to get approval here is going to be lingering and because I don't know if the company is going to pick it up for the purpose of pursuing a patent.

It's a complicated process, David.

But when that happens and a medication is not approved, the United States and there's not a pharmaceutical company able or willing to be able to retain a patent on that, it just doesn't move.

>> So it's a medication that I think is can be potentially very effective for depression and I'd love to see some pharmaceutical company pick up a variation of that medication so we could actually bring it to market here.

But yeah, in Europe they have medications that the FDA approved for not only schizophrenia but for depression that we don't have access to to being able to use and but that's one I'd love to be able to use here in United States.

But we just don't have access to right now what often happens in those kind of situations, David, is people pharmaceutical companies will make a variation of it.

They'll put a chlorine group on the medication.

They'll look at the left side or the right sided piece because medications have left side on the right side of pieces.

Sometimes they'll look at the more potent piece and they'll use that piece as a means of bringing to market.

>> For instance, right now there's discussion about using the right sided piece of methadone you I think on methadone that's an opiate medication but the right side of the piece is not addictive and does not cause respiratory suppression and can potentially be used as a pretty darn good antidepressant medication.

>> So not the left side of the piece the left side piece of methadone is the piece that is is responsible for the addiction, the respiratory depression that's the part that kills you.

The right side of the piece by itself can be used pretty well for depression and give you that sense of bliss and sense of happiness without giving all the addictions.

So this is what pharmaceutical companies will often do and for a pharmaceutical company to pursue that they have to be able to own that particular molecule and the problem with various medications out there that are very effective and now approved in Europe is there's not ownership the United States without ownership of those kind of medications, the United States you can't really bring them to market because a company doesn't really have the incentive to be able to do long term studies on those it takes up to a billion dollars to be able to research a medication to the point of getting it to market David and that's part of the problem right now the funding for research of a medication that hasn't been FDA approved.

>> David, thanks for your call.

Let's go to next caller.

Hello, Thomas.

Welcome to Mars the mind.

Well, Thomas, you want me to elaborate on a different types of shots to treat schizophrenia the more effective shots what's the time period of these shots and how do they treat schizophrenia?

Well, basically the shots are no different than the oral medications.

So basically the shots are a means of taking the oral formulation and putting it in an injection form and we have shots for Risperdal which is called Risperdal.

Costel we have in Vegas, Austin in Vegas is the active byproduct of Risperdal and it comes to sustain a form which lasts for a whole month.

There's Abilify that gives you one month duration for Abilify but there's Abilify Mentana that can go on for a month.

There's another type of Abilify Gowland for giving you a duration of action of three months.

It basically what these medications are doing, Thomas, is they're slowly releasing the medication over the course of several weeks and then time over several months and there's medications in development for injection that will actually actually last for six months now why is this important, Thomas Wells?

Because people with schizophrenia by nature of their having schizophrenia aren't often aware that they have an illness when the illness progresses to a degree and it's really affecting this part of the brain in here.

This temporal lobe is right over here, the yellow part and then this crease between the parietal lobe and the temporal lobe it's a part of the brain called the insula and the insula is the self awareness part of the brain in this part of the brain is thought to be impaired with people who are severely mentally ill and for people who have conditions like schizophrenia and part of the problem with that is you can't convince people that they have an illness.

When I was a third year medical student a long time ago, I thought well gee, this psychiatry gig is pretty simple.

You just convince people that and reason with them that they don't really have all these different problems they perceive they're not they're paranoid thoughts are not justified.

They can't possibly be hearing all these voices talking to them because nobody else can hear them and you just try to reason with them.

>> Well, by nature of people having delusions, which is a fixed false belief fixed false beliefs there are fixed because you can't talk them out of them and they're false because they're not possibly true.

So that's what a delusion will be.

A hallucination is a perceptual disturbance where they are truly hearing voices that nobody else can hear and if you look at their brainwaves that time, their brainwaves are being activated in such a way that it appears that they are indeed hearing true voices.

>> So with that being said, long term antipsychotic medications also known as long acting injectable medications will be really the future of treatment for all of these people with schizophrenia because if they get the medication injection once a month, perhaps every three months and some day every six months it'll decrease their likelihood of getting sick again and again again.

>> And with schizophrenia the more times you have a psychotic episode it's not unlike somebody who's had a seizure the more time somebody has a seizure, the more likely they're going to have more seizures and a more like they're going to be more difficult to treat with schizophrenia.

The more psychotic episodes somebody has.

Well, there's actually brain disturbances and brain damage in such a way that there's excessive glutamate released with excess sensitive glutamate release.

It causes a toxicity to the brain itself.

So there's actually brain damage with repeated psychosis.

>> That's why email trapline over one hundred years ago actually called he called schizophrenia by a name of called dementia praecox because he looked at the brain biopsy's after people died.

>> He looked at their brains and these people that we now know as having schizophrenia they had shrunken areas of the brain not unlike people with Alzheimer's disease, how they had shrunk areas of the brain.

So he thought schizophrenia was a form of dementia because they had these particular areas of the brain that were shrunken.

So with schizophrenia, with repeated psychosis it actually does more and more damage and more and more damage to the brain causing people to have memory to Durban's thinking disturbances and further impairs their awareness that they have an illness with each psychotic episode.

So we're trying to catch these kind of conditions as early as possible, keep people out of the hospital, keep their psychoses under control and the longer they can they can stay well the more likely to have overall improvement with functioning and functioning is what it's all about.

When we talk about functioning in mental health , we're talking about the ability to go to school, be able to go to work, be able to have social relationships.

>> People have a stable family life .

That's what we're talking about.

That's our ultimate goal in mental health treatment.

And when people have a mental illness, whether be schizophrenia, depression, anxiety disturbances, what happens is they get to a point where they can't function on a day to day basis in normal and in society and when you can't function normally in society that's where you cross the line in terms of just having a quirk and just having normal mood shifts, normal anxieties and normal fears to the point of having a mental illness.

And that's what we're trying to preserve with people with conditions like schizophrenia and more severe mental illnesses.

Now the medication will only be a part of the treatment.

Number two , you always want to have a case manager involved because case managers are basically people who kind of keep an eye on how you're doing.

They check up on you every now and then.

You know, I'm a physician.

I'm a prescribing clinician so I will prescribed medications.

I can recommend medications but it means nothing if somebody doesn't take the medication or if they don't then follow through with getting themselves busy and doing things back in the old days people used to take medication.

Then they go home and sit and watch TV all day and they didn't do anything.

Nowadays we expect people with schizophrenia to have lives to have social relationships.

>> They need things to do and we have this network of what's called clubhouses available.

We do indeed have one in Fort Wayne where I work and in Fort Wayne is called the Carriage House Clubhouse but the clubhouse is ah a place where people can go as they're recovering from their mental illness.

They have meaningful relationships.

They have productive activities.

They have purpose in what they're doing on a day to day basis.

And it's these clubhouses are typically open Monday through Friday where people can go at least during the day for eight hours and they can learn job skills.

They can learn how to interview.

They can complete or GED if they've not completed that to get their high school diploma and they can have meaningful activities where they have something to do on a day to day basis.

The worst thing you can do with a severe mental illness is just to go home and do nothing because that actually propagates them symptoms themselves and social isolation will often cause you to have more psychosis, more of a likelihood of hearing voices and give you difficulty with being able to concentrate and think through your daily activities.

So it's important that you be around people on a day to day basis so the medications start the medication will basically get the neurobiology of the brain working again but then you have to take the next step to be around people to have meaningful and productive productive activity and do things on a day to day basis.

It's highly predictive that people will relapse into their illness if they're socially isolated and they're not doing things and they're not interacting with people on day to day basis.

The more people are able to be productive the more likely they're going to be able to recover from their illness, stay on the medication because they'll probably need the medication long term but they can recover from the the social isolation.

They can recover from the illness itself and live a productive life .

>> Thanks for your call.

Let's go to next email.

>> Our next email reads Dear Dr. Fauver, how long should a person stay on an antidepressant have taken Celexa for two years and I'm not sure if I should stay on it.

Well, that's a question that we often encounter on a day to day basis as we're talking to people as clinicians we often talk about you know, we want this time of stability to be at least one year.

So you want to stay well for at least one year with any antidepressant medication, whether it be Celexa or anything else.

So you want to be well for a year that means you have a minimum of symptoms and you certainly don't have any functional impairment.

You're sleeping normally.

You're getting out, you're going to work or being around people you're interacting with individual in a productive and somewhat normal manner.

So you're not having any trouble with wanting to lay in bed all the time not having episodes where you're crying out of the blue you're living pretty much a normal life for a whole year after that time you look at the pros and cons of going off the medication or staying on it No one is the medication tolerable for you?

Is it causing any side effects?

Number two , how many spells of depression have you had in the past if you've had three or more spells of depression each lasting for at least two weeks, the general rule of thumb will be three strikes and you're on if you've had three bad spells of depression in your lifetime it's over 90 percent likely that without medication treatment you're going to have another bad spell in the future.

>> So you have to consider that another factor will consider will be your family history.

If you have a lot of people in your family with depression, it's more likely you want to be on the antidepressant medication long term.

Another factor would be if you had a really bad Bella depression in the past where you actually made suicidal attempts and you had dangerous depressive episodes in the past that might be a reason to stay on the medication if you're currently undergoing a lot of medical conditions like a heart condition, lung condition, you're enduring cancer.

You might want to stay on the depressant medication at that time.

So that would be a factor.

Your medical condition if you're currently using any alcohol, marijuana, opiate medications as a means of trying to self medicate you might want to steal in the depression medication to try to help you stay off of those substances of abuse and might even want to consider looking at a different medication itself because if you're in a depressed medication itself is not keeping you from needing to self medicate or having that temptation, you might want to consider another route as well.

>> So we look at all of these different considerations in terms of whether somebody is a good candidate to stay on their medication or go off of a so talk it over with your prescribing clinician and see if this is a good time for you to go off the medication.

>> I saw a young lady this afternoon who had been doing well for several months with a brief psychotic condition.

It was directly related to covid and we indeed after that what's going on eight months now we're starting to back off her medications and we're hoping she'll be on no medications at all.

So in that case we could directly say that her covid infection was related to her psychotic episode and her difficulty with thinking at that time we've treated her since and we've got her stabilized but we're hoping to be able to get her off the medication over the next couple of months.

>> Thanks for your call.

Let's go our next caller.

Hello Ryan.

Welcome to Matters of Mind.

>> All right.

You'd wondered can mental health be contagious in respect to someone who suffered who lives with someone who suffers from depression?

>> Can that depression be contagious?

It's not biologically contagious, Ryan, but mental health conditions can have an impact just causing you stress you might not have otherwise head.

>> So if you live with a family member who has mental illness, it's it's trying for you.

I mean it'll cause you to be undergo some stress.

And as I mentioned before, if you think about the concept of epigenetics where you're we're all genetically wired a certain way, we can't help that.

That's how our genetics will be.

But you have this concept of epigenetics where our chromosomes are wrapped with histones which are kind of like the wrapping and for pigs in a blanket if you're in during the depressive symptoms of another family member day by day by day it can kind of get to you and you are more prone to depression because your little histones can be kind of opened up a bit where you can have over methylation which means over inhibiting of certain genes or over acetylation where your genes are overly activated.

That's what causes some of the neurobiological disturbances with mental illness itself.

And we see that not only the mental but also with other kind of medical conditions.

Why do people who get more stressed out why are they more prone to heart disease, lung disease and even cancer?

It's because these little histones are opening up and it's exposing genetic that shouldn't be otherwise exposed and is causing you to have disturbances in that manner.

So we're all prone to having genetics for depression, anxiety, even schizophrenia for that matter.

But we want to express those kind of symptoms unless certain factors emerge.

One of the more genetic conditions we have will be for instance, schizophrenia.

If you have a identical twin with schizophrenia exact same chromosomes as yours as you you have a 50/50 chance of getting schizophrenia yourself.

That means 50 percent chance of not getting schizophrenia, which means that it's not entirely genetic.

You have to have certain environmental factors that will affect those genes that are there and we see this and a lot of other conditions as well.

>> Thanks for your call.

Let's go to next caller.

Hello, Mike Walker is the mind.

Mike, you wondered because memories are recorded genetically with brain chemicals and brain can brain chemicals affect memories, traits or mood?

Can they be inherited?

I'm not really clear what your question might be.

OK, here we go again.

Can know that's a different question you're asking if memories can be recorded genetically from past family members.

I don't think based on the question you're asking your memories are recorded based on your recollections and your experiences.

I I'm not aware of any possibility of genetics influencing your memories and you having the memories that you're descent that your ancestors might have experienced.

For instance, if your grandfather was exposed to combat in Vietnam or World War Two for that matter.

Are you going to have those memories?

>> No, I don't think the memories would shift in that matter because your genetics are your hard wiring and your genetics don't absorb the memories from past ancestors but so you wouldn't be genetically based on those memories to having a condition like post-traumatic stress.

However, you can have the genetics that could predispose you to post-traumatic stress and I'll give you an example of that.

>> There's a serotonin transporter called FSLIC six a four and it's a gene that's recorded by SLC six eight four .

>> And if you have an SS Aleo which are shorter alleles for four SLC six eight four, you are more prone to being stressed out and anxious and depressed in the event that you had early childhood trauma and perhaps later childhood later trauma as an adult as well.

So you have the genetics that might put you at greater risk for anxiety or depression but the genetics have to be activated by certain environmental stresses and if you didn't personally experience those environmental stresses you're probably not going to inherit those type of memories from an ancestor.

>> Thanks for your call.

Let's go our next caller.

Hello Margaret.

Welcome to Matters of Mind.

Hi Margaret.

Hello.

I had a question about Alzheimer's.

Is there any medications that they've come up with that can help slow the process down so a person can maybe have a better life for a few years longer?

>> Yes, there have been since 2001 actually in nineteen ninety eight I believe several medications have emerged.

>> They kind of work kind of like Russ Proofers do on your patio furniture.

>> Margaret what these medication is do is they slow the process and allow you to have a better quality of life over the course of time with Alzheimer's but they don't they don't cure it.

>> We're always looking for that cure on Alzheimer's and it's so difficult to find them.

We have medications like Aricept, Exelon Rhapsodizing and Namenda.

These are all medications to basically slow the process and slow the impairment that's emerging for Alzheimer's disease.

>> They've been around for quite some time and various ways they will act on acetylcholine, Aricept, Excelon and rhapsodized will basically enhance the transmission of acetylcholine a decrease the likelihood acetylcholine is going to be broken down.

And one of the problems with Alzheimer's disease, Margaret, is that you have this chemical called acetylcholine which tends to decrease in its activity and that caused you to have memory impairment that's affecting the side part of the brain primarily on each side and Aricept, Excelon and rhapsodized will enhance the transmission of acetylcholine in that matter, Namenda is a medication that will block a particular receptor in the brain called NMDA receptors and doing so can decrease the potential damage that's emerged from Alzheimer's disease and sometimes Amanda is added to Aricept and is called NEMS Eric as a combination product and that sometimes can give people more prolonged functioning but they're not curative but they do help somebody quality of life overall.

Margaret Margaret, thanks for your call.

Unfortunately I'm out of time for this evening if you have any questions concerning mental health issues that I can answer on the air, you may write me a via the Internet at matters of the mind all one word at W f w a dot org.

>> I'm psychiatrist J Farber and you've been watching Matters the Mind on PBS wane God willing and PBS willing.

>> I'll be back again next week.

Have a good evening.

Good night